- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $181.97 / $416.87 / $758.58
| Facility | 26 | $181.97 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $407.38 / $776.25
| Professional | | $251.19 | $407.38 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $112.20 / $169.82
| Professional | 26 | $70.79 | $112.20 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $281.84 / $512.86
| Professional | TC | $181.97 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $53.70
| Professional | 26 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Facility | 26 | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $512.86 / $870.96
| Professional | | $229.09 | $512.86 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $50.12 / $81.28 / $147.91
| Professional | 26 | $50.12 | $81.28 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $173.78 / $416.87 / $758.58
| Professional | TC | $173.78 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $346.74 / $416.87
| Professional | | $251.19 | $346.74 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $67.61 / $93.33 / $112.20
| Professional | 26 | $67.61 | $93.33 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $181.97 / $257.04 / $302.00
| Professional | TC | $181.97 | $257.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $281.84 / $707.95
| Professional | | $239.88 | $281.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $61.66 / $72.44 / $109.65
| Professional | 26 | $61.66 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $177.83 / $208.93 / $616.60
| Professional | TC | $177.83 | $208.93 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $363.08 / $707.95
| Professional | | $194.98 | $363.08 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $47.86 / $79.43 / $151.36
| Professional | 26 | $47.86 | $79.43 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $630.96
| Professional | TC | $144.54 | $269.15 | $630.96 |